Provider Demographics
NPI:1669807020
Name:WEENIG, JOSHUA AMMON (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:AMMON
Last Name:WEENIG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PECOR ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1768
Mailing Address - Country:US
Mailing Address - Phone:920-834-5737
Mailing Address - Fax:
Practice Address - Street 1:1210 PECOR ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153
Practice Address - Country:US
Practice Address - Phone:920-834-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001796-15122300000X
FLDN 20217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist